Provider Demographics
NPI:1639713431
Name:IVEY, LOREN (NP, CNM)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:IVEY
Suffix:
Gender:F
Credentials:NP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:19450 DEERFIELD AVE STE 460
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6840
Practice Address - Country:US
Practice Address - Phone:571-707-8522
Practice Address - Fax:571-707-8577
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2023-10-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024178281OtherVA